I was in a long distance relationship for 18 months. We lived about 2,000 miles apart, so I too broke up over the phone. It was very emotional for me, so I started by writing out the main points I wanted to address and why I thought the relationship couldn’t progress any further. I thought he was a great guy, so I wanted to give him a full explanation. At the same time, nothing was new to him. We had discussed it all in earlier conversations. We had tried to work on the issues. First, be sure that this is what you want. If you are sure try the following.
Write a summary of what you want to say. I practiced what I was going to say in my head until I had the right words, though of course it was just a general idea. It changed as we interacted. Try to stay calm. Be direct and get right to the point of the call. Don’t place blame. Be respectful and listen to what he has to say, but don’t let it drag on. It won’t be easy or pleasant, but try to keep it as “nice” as possible. You should read the stickies in this forum about breaking up, no contact, and what to expect. Even though you are the one breaking up, you will most likely have a reaction to this. Be prepared.
As to what to say, be honest. You know why you want to break up. Don't feel bad about the promise made about long distance. No one knows what an LDR is like until they are in it. It sounds romantic at first, but it is hard work. You need to concentrate on school now. Medicine is a very hard field, as you know. Good luck.
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